Despite being known risk factors for poor cardiovascular outcomes, blood pressure and low-density lipoprotein (LDL) cholesterol remain under-treated among a large proportion of patients.
In a new study, researchers developed a program that provides an end-to-end solution to improve blood pressure and cholesterol levels across a broad population of patients at high heart disease risk.
The research was conducted by a team from Brigham and Women’s Hospital and Mass General Brigham Health System.
Developed before the COVID-19 pandemic, the disease management program leverages task shifting, standardized treatment algorithms, and digital solutions such as home blood pressure cuffs to adjust medications based on how a patient is doing.
The program relies on a team of navigators and pharmacists to help deliver personalized care remotely, without the need for in-person visits or physician involvement in every treatment decision.
In their paper, the team summarized the interim results of the first 5,000 Mass General Brigham patients with uncontrolled LDL cholesterol, blood pressure or both, who were enrolled between Jan. 1, 2018, and May 21, 2020.
Patients were mostly prescribed lower-cost generic drugs through the program.
Pharmacists initiated and adjusted prescriptions for individuals based on clinical algorithms, prescribing more intensive medications if a patient needed them or adjusting a dosage if a patient was initially intolerant to a medication.
Non-licensed navigators served as the face of the program. They communicated directly with patients, providing treatment recommendations and education until treatment goals were met.
Digital tools helped support the workflow and clinical decisions for the navigators and pharmacists.
The program was supervised by specialists, and primary care physicians were updated on all treatment changes.
Of the 3,939 patients in the Lipid program, 1,343 had achieved their goal LDL cholesterol level by the time of this report, with the average decrease in LDL cholesterol being 52 mg/dl (42 percent).
An overall drop in cholesterol levels of 24 mg/dl (18 percent) was seen in all patients, including those still being actively managed.
Of the 1,437 patients enrolled in the high blood pressure group, blood pressure levels dropped by an average of 14/6mmHg (systolic/diastolic) in the 556 who had completed the program by the time of this report.
The team says these reductions are clinically meaningful. Reductions of this magnitude in blood pressure and cholesterol result in fewer heart attacks, strokes and other cardiovascular events.
They hope the work provides a foundation for future broadly delivered population health initiatives.
One author of the study is Brigham cardiologist Benjamin Scirica, MD, MPH.
The study is published in Circulation.
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